Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Study shows for first time decrease in mortality associated with physician order entry system

03.05.2010
Researchers at Lucile Packard Children's Hospital and Stanford University School of Medicine have shown for the first time that a significant decrease in hospital-wide mortality rates can be associated with implementation of a computerized physician order entry system.

The system, launched at Packard Children's in 2007, was correlated with a 20 percent decrease in mortality rates at the hospital over an 18-month period, according to a new study to be published online May 3 in Pediatrics. Researchers noted that other patient care initiatives at the hospital may also have contributed to this important change.

With CPOE, doctors and other medical staff can prescribe medications, tests and other treatments electronically, making the instructions instantly and remotely available to all authorized hospital staff, even when off-site. CPOE is part of the hospital's electronic medical record, which also provides on screen the latest images and test results. All physicians need to do is boot up a computer, punch in a password and the heartbeat of a child in the neonatal intensive care unit will trace across the screen, or a brain scan can be viewed.

The study arrives as a debate rages over the benefits of CPOE and electronic medical records. While many proponents, including the Obama administration, see these new technologies as critical to improving the quality of our health-care system, critics contend their value has yet to be proven, particularly as some past research has shown negative consequences, including one site that witnessed an increase in mortality.

"Prior to our report, no hospital or medical institution has shown that CPOE can be implemented and actually have an associated decline in mortality," said lead author Christopher Longhurst, MD, medical director of clinical informatics at Packard Children's and assistant clinical professor of pediatrics at Stanford. "But what we found is that CPOE implementation was statistically correlated with fewer patient deaths. As you can imagine, this is very meaningful." Longhurst was part of a team of eight researchers from Packard Children's, Stanford and Harvard University involved in the study.

Mark Del Beccaro, MD, a pediatrics professor and vice chair for clinical affairs at Seattle Children's Hospital, who was not involved in this study, said he welcomed the new findings. Seattle Children's Hospital implemented CPOE in 2003. "Three years later a study of the effects showed mortality rates at our institution held steady," Del Beccaro said. "As the evolution and maturity of these systems and their benefits are being realized, there has been soft evidence that they improve patient safety. The Packard Children's report is the first I am aware of to show that you can potentially affect mortality by putting CPOE in place. This is an important study, and we hope others can realize these benefits."

Longhurst emphasized that the new results show a correlation, not a cause and effect. "Our implementation of CPOE was executed superbly, but in addition, we were simultaneously making other advances in patient care," he said. "These included process and workflow changes, adjustments in ICU staffing, the rollout of Rapid Response Teams, the implementation of a nursing residency and more, all in the face of rising acuity in the hospital."

To determine if a change in mortality rates occurred, Longhurst and his colleagues reviewed nearly 100,000 discharges from Packard Children's from Jan. 1, 2001, through April 30, 2009. They compared the observed mortality with the expected mortality, which was generated from a database of 42 tertiary-care, not-for-profit pediatric hospitals similar to Packard Children's.

The result of their analysis was a finding of two fewer deaths per 1,000 discharges at Packard Children's in the period after CPOE was implemented, a total of 36 lives over 18 months.

There are many ways CPOE can have a lifesaving impact. With CPOE, crucial data and suggestions that can help guide clinical decisions pop up on the screen as the doctor types in orders and other information about the patient. There will be, for instance, a friendly electronic nudge if a dosing calculation appears to be in error. And it can improve efficiency. "We've seen a 20 percent improvement in the time from order to administration for 'stat' [immediate] medications," noted Longhurst. "This can have lifesaving consequences."

Still, it's important to remember that CPOE, and electronic medical records in general, are simply technology tools that support or "hard-wire" best practices into the work environment. "Simply purchasing a fancy and expensive electronic medical records system in and of itself is not likely to make much of a positive impact on quality or patient safety," said Paul Sharek, MD, MPH, medical director of quality management and chief clinical patient safety officer at Packard Children's. "What provides the real opportunities for improving care is using this technology to support best practice, such as displaying relevant blood test results at the time physicians are ordering medications, or allowing practice guidelines to be immediately available to physicians at the time of order entry." Sharek, who is an assistant professor of pediatrics at the medical school, is the study's senior author.

Longhurst concluded: "We believe our experience is proof that CPOE is here to stay. However, to be successful, it takes an unwavering commitment to implementation. Our staff was very supportive, seeing it as a critical part of a hospital-wide commitment to continuous improvement in patient care. This approach gave us a better chance to determine if CPOE really has an impact in a hospital setting."

Other Stanford/Packard Children's authors on the study are Christopher Dawes, MBA, the hospital's president and chief executive officer; Jill Sullivan, RN, MSN, vice president of hospital transformation; Christy Sandborg, MD, professor of pediatric rheumatology and the hospital's chief of staff; Jin Hahn, MD, professor of pediatric neurology; and Eric Widen, MHA, administrative director of performance improvement at the hospital.

The Stanford University School of Medicine consistently ranks among the nation's top medical schools, integrating research, medical education, patient care and community service. For more news about the school, please visit http://mednews.stanford.edu. The medical school is part of Stanford Medicine, which includes Stanford Hospital & Clinics and Lucile Packard Children's Hospital. For information about all three, please visit http://stanfordmedicine.org/about/news.html.

Ranked as one of the best pediatric hospitals in the nation by U.S.News & World Report, Lucile Packard Children's Hospital at Stanford is a 312-bed hospital devoted to the care of children and expectant mothers. Providing pediatric and obstetric medical and surgical services and associated with the Stanford University School of Medicine, Packard Children's offers patients locally, regionally and nationally the full range of health-care programs and services — from preventive and routine care to the diagnosis and treatment of serious illness and injury. For more information, visit http://www.lpch.org

Robert Dicks | EurekAlert!
Further information:
http://www.lpch.org

More articles from Studies and Analyses:

nachricht Rutgers-led innovation could spur faster, cheaper, nano-based manufacturing
14.02.2018 | Rutgers University

nachricht New study from the University of Halle: How climate change alters plant growth
12.01.2018 | Martin-Luther-Universität Halle-Wittenberg

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: In best circles: First integrated circuit from self-assembled polymer

For the first time, a team of researchers at the Max-Planck Institute (MPI) for Polymer Research in Mainz, Germany, has succeeded in making an integrated circuit (IC) from just a monolayer of a semiconducting polymer via a bottom-up, self-assembly approach.

In the self-assembly process, the semiconducting polymer arranges itself into an ordered monolayer in a transistor. The transistors are binary switches used...

Im Focus: Demonstration of a single molecule piezoelectric effect

Breakthrough provides a new concept of the design of molecular motors, sensors and electricity generators at nanoscale

Researchers from the Institute of Organic Chemistry and Biochemistry of the CAS (IOCB Prague), Institute of Physics of the CAS (IP CAS) and Palacký University...

Im Focus: Hybrid optics bring color imaging using ultrathin metalenses into focus

For photographers and scientists, lenses are lifesavers. They reflect and refract light, making possible the imaging systems that drive discovery through the microscope and preserve history through cameras.

But today's glass-based lenses are bulky and resist miniaturization. Next-generation technologies, such as ultrathin cameras or tiny microscopes, require...

Im Focus: Stem cell divisions in the adult brain seen for the first time

Scientists from the University of Zurich have succeeded for the first time in tracking individual stem cells and their neuronal progeny over months within the intact adult brain. This study sheds light on how new neurons are produced throughout life.

The generation of new nerve cells was once thought to taper off at the end of embryonic development. However, recent research has shown that the adult brain...

Im Focus: Interference as a new method for cooling quantum devices

Theoretical physicists propose to use negative interference to control heat flow in quantum devices. Study published in Physical Review Letters

Quantum computer parts are sensitive and need to be cooled to very low temperatures. Their tiny size makes them particularly susceptible to a temperature...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

2nd International Conference on High Temperature Shape Memory Alloys (HTSMAs)

15.02.2018 | Event News

Aachen DC Grid Summit 2018

13.02.2018 | Event News

How Global Climate Policy Can Learn from the Energy Transition

12.02.2018 | Event News

 
Latest News

Researchers invent tiny, light-powered wires to modulate brain's electrical signals

21.02.2018 | Life Sciences

The “Holy Grail” of peptide chemistry: Making peptide active agents available orally

21.02.2018 | Life Sciences

Atomic structure of ultrasound material not what anyone expected

21.02.2018 | Materials Sciences

VideoLinks
Science & Research
Overview of more VideoLinks >>>